Provider Demographics
NPI:1265556377
Name:HYDE PARK OPTOMETRY
Entity type:Organization
Organization Name:HYDE PARK OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MURNIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-229-5281
Mailing Address - Street 1:15 PARK PL
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1231
Mailing Address - Country:US
Mailing Address - Phone:845-229-5281
Mailing Address - Fax:
Practice Address - Street 1:15 PARK PL
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1231
Practice Address - Country:US
Practice Address - Phone:845-229-5281
Practice Address - Fax:845-229-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01792350Medicaid
NYU63210Medicare UPIN